Provider Demographics
NPI:1760660583
Name:JOHN J ZISA
Entity Type:Organization
Organization Name:JOHN J ZISA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZISA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-942-4545
Mailing Address - Street 1:85 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1812
Mailing Address - Country:US
Mailing Address - Phone:973-942-4545
Mailing Address - Fax:973-942-3966
Practice Address - Street 1:85 BERKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1812
Practice Address - Country:US
Practice Address - Phone:973-942-4545
Practice Address - Fax:973-942-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00152900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4059970001Medicare NSC